Earlier this week, the American Dental Association released an economic analysis of three different midlevel provider models, the Dental Health Aide Therapists (DHATs) currently working in Alaska Native territories, the Dental Therapists (DTs) working in Minnesota, and the Advanced Dental Hygiene Practitioner that is supported by the American Dental Hygienists’ Association. The studies include economic modeling for each of the three dental midlevel providers in public health settings in Washington, Kansas, Connecticut, New Hampshire, and Maine. A separate summary report of all five states is also available.
The ADA report conducted 45 different economic scenarios by using three different payer mixes for each of the three midlevel provider models in all five states. Only five of the scenarios had positive net revenues (where revenues generated by practitioner exceeded expenses). Four of the positive net revenue scenarios involved the DHAT model and the fifth positive net revenue scenario involved the DT model. Of the three models, the ADHP was the least economically viable. None of the nine economic scenarios in Washington had positive net revenue. The Washington scenario with the lowest negative net revenue was the DHAT model with a 50 percent Medicaid/50 percent private insurance payer mix.
WSDA applauds the ADA for commissioning this report. While the results raise questions about the economic viability of dental midlevel providers and their ability to reduce the multiple barriers to improving the oral health of the underserved; it is lacking a baseline (including the outcomes of a dentist in the same model) and uses some assumptions which are not reflective of current education costs or projected overhead costs such as rent and equipment. This is just the first attempt at quantifying midlevels which will be followed by more sophisticated modeling addressing these inadequacies.
Creating additional workforce models does nothing to address the two primary barriers to dental care in Washington: chronic underfunding of the dental safety net and low oral health literacy. A WSDA report that identifies barriers to care and provides several solutions to improve access can be found here.
Questions about dental midlevel providers can be directed to WSDA Director of Government Affairs, Bracken Killpack at firstname.lastname@example.org or at 800-448-3368.